Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China.
Department of Laboratory, Peking University First Hospital, Beijing, 100034, China.
BMC Nephrol. 2020 Apr 25;21(1):149. doi: 10.1186/s12882-020-01808-7.
Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries.
This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 7 days postoperatively in the hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis.
Of the 74,284 surgeries, 4.4% (3159 cases) suffered acute kidney injury. The odds ratio for HDL (0.96-1.14 as reference, < 0.96, 1.14-1.35, > 1.35) was 1.28 (1.14-1.41), P < 0.001; 0.91 (0.80-1.03), P = 0.150; 0.75 (0.64-0.85), P < 0.001, respectively. Using a dichotomized cutoff point for propensity analysis, Preoperative serum HDL < 1.03 mmol/L (> 1.03 as reference) was associated with increased risk of postoperative AKI, with odds ratio 1.40 (1.27 ~ 1.52), P < 0.001 before propensity score weighting, and 1.32 (1.21-1.46), P < 0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results.
Using multivariate regression analyses before and after propensity score weighting, in addition to multiple sensitivity analysis methods, this study found that following non-cardiac surgery, low HDL cholesterol levels were independent risk factors for AKI.
异常高密度脂蛋白胆固醇浓度与心脏手术后的术后急性肾损伤（AKI）密切相关。本研究的目的是分析非心脏手术后高密度脂蛋白胆固醇浓度与急性肾损伤之间的关系。
这是一项单中心队列研究，纳入 2012 年 1 月 1 日至 2017 年 12 月 31 日期间择期行非心脏非肾脏手术的患者。术后 7 天内发生急性肾损伤（AKI）是该研究的终点。通过多元逻辑回归模型在倾向评分加权分析前后检查术前血清高密度脂蛋白胆固醇浓度。
在 74284 例手术中，有 4.4%（3159 例）发生急性肾损伤。HDL 的比值比（0.96-1.14 为参考，<0.96、1.14-1.35、>1.35）分别为 1.28（1.14-1.41）、P<0.001；0.91（0.80-1.03）、P=0.150；0.75（0.64-0.85）、P<0.001。使用倾向分析的二分切点，术前血清 HDL<1.03mmol/L（>1.03 为参考）与术后 AKI 的风险增加相关，比值比为 1.40（1.27~1.52）、P<0.001，在进行倾向评分加权之前，1.32（1.21-1.46）、P<0.001，在进行倾向评分加权之后。使用其他 HDL 切点值的敏感性分析显示了相似的结果。
使用多元回归分析在进行倾向评分加权前后，以及多种敏感性分析方法，本研究发现非心脏手术后低 HDL 胆固醇水平是 AKI 的独立危险因素。
